INTRODUCTION: Lymph node (LN) positive bladder cancer is a serious disease associated with a poor prognosis. Nevertheless even after radical cystectomy and lymph node dissection alone long-term oncologic control has been reported in a subset of these patients. Efforts have been made to stratify LN-positive patients according to various prognostic factors to make more individualized risk estimations. This review attempts to summarize the existing data on prognostic determinants in node-positive bladder cancer.EVIDENCE ACQUISITION: A literature search of the English literature was performed in October 2015 on PubMed using the search terms “bladder cancer”, “node-positive” and “prognosis/outcome”. Papers were only selected when separate information on the node-positive subpopulation was available. Data from prospective studies, meta-analysis or multi-institutional were selected primarily.EVIDENCE SYNTHESIS: Current 2010 TNM classification of nodal disease seems to have limited prognostic value. Several other nodal parameters such as number of positive nodes, number of resected nodes, LN density and extracapsular extension have been extensively evaluated and show potential in distinguishing prognostic subgroups. Although node-positive bladder cancer is often seen as systemic disease local tumor characteristics such as T stage and histological variants seem to remain important. Molecular markers are promising in stratifying patients with bladder cancer but need further validation in a specific node-positive subgroup. Neo-adjuvant chemotherapy seems to improve the prognosis of clinical node-positive patients and evaluation of response could help in selecting patients who benefit from consolidating surgery. Although retrospective studies convincingly suggest improved clinical outcome with adjuvant chemotherapy for pathological node-positive patients, these findings are not consistently confirmed in recent prospective studies. CONCLUSIONS: Future research should aim at the incorporation of prognostic variables into clinically applicable nomograms and identification of the subgroup of patients who will benefit from adjuvant treatments.